Diabetic nerve damage is called neuropathy (ne-ROP-uh-thee). Neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, have damage to nerves throughout the body. Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet and legs. Problems may also occur in every organ system, including the digestive tract, heart and reproductive organs. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk.
An estimated 50 percent of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years.
Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat (high cholesterol) and high blood pressure, in overweight people and in people over the age of 40. The most common type is peripheral neuropathy, also called “distal symmetric neuropathy”, which affects the arms and legs.
The causes are probably different for different varieties of diabetic neuropathy. Researchers are studying the effect of glucose on nerves to find out exactly how prolonged exposure to high glucose
(blood sugar) causes neuropathy. Nerve damage is likely due to a combination of factors:
 metabolic factors, such as high blood glucose, long duration of diabetes, possibly low levels of insulin and abnormal blood fat levels
 neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to the nerves
 autoimmune factors that cause inflammation in nerves
 mechanical injury to nerves, such as carpal tunnel syndrome
 inherited traits that increase susceptibility to nerve disease
 lifestyle factors such as smoking or alcohol use

Symptoms depend on the type of neuropathy and which nerves are affected. Some people have no symptoms at all. For others, numbness, tingling or pain in the feet is often the first sign. A person can experience both pain and numbness. Often, symptoms are minor at first, and since most nerve damage occurs over several years, mild cases may go unnoticed for a long time.
Symptoms may include
 numbness, tingling or pain in the toes, feet, legs, hands, arms and fingers
 wasting of the muscles of the feet or hands
 indigestion, nausea or vomiting
 diarrhea or constipation
 dizziness or faintness due to a drop in blood pressure
 problems with urination
 erectile dysfunction (impotence) or vaginal dryness
 weakness
In addition, the following symptoms are not due to neuropathy but nevertheless often accompany it:
 weight loss
 depression
Diabetic neuropathies can be classified as peripheral, autonomic, proximal and focal. Each affects different parts of the body in different ways.
 Peripheral neuropathy causes either pain or loss of feeling in the toes, feet, legs, hands and arms.
 Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response and perspiration. It can also affect the nerves that serve the heart and control blood pressure. Autonomic neuropathy can also cause hypoglycemia (low blood sugar) unawareness, a condition in which people no longer experience the warning signs of hypoglycemia.

 Proximal neuropathy causes pain in the thighs, hips or buttocks and leads to weakness in the legs
 Focal neuropathy results in the sudden weakness of one nerve, or a group of nerves, causing muscle weakness or pain. Any nerve in the body may be affected.
The best way to prevent neuropathy is to keep your blood glucose levels as close to the normal range as possible. Maintaining safe blood glucose levels protects nerves throughout your body.
For additional information on preventing diabetes complications, including neuropathy, see the Prevent
Diabetes Problems series, available from the National Diabetes Information Clearinghouse.
The first step is to bring blood glucose levels within the normal range to prevent further nerve damage.
Blood glucose monitoring, meal planning, exercise and oral drugs or insulin injections are needed to control blood glucose levels. Although symptoms may get worse when blood glucose is first brought under control, over time, maintaining lower blood glucose levels helps lessen neuropathic symptoms.
Importantly, good blood glucose control may also help prevent or delay the onset of further problems.
 Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose.
 Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet or legs, and problems with the digestive tract, heart and sex organs.
 Treatment first involves bringing blood glucose levels within the normal range. Good blood glucose control may help prevent or delay the onset of further problems.
 Foot care is another important part of treatment. People with neuropathy need to inspect their feet daily for any injuries. Untreated injuries increase the risk of infected foot sores and amputation.

 Treatment also includes pain relief and other medications as needed, depending on the type of nerve damage.
 Smoking significantly increases the risk of foot problems and amputation. If you smoke, ask your health care provider for help in quitting.
Source: National Institute of Diabetes and Digestive and Kidney Disease - http://diabetes.niddk.nih.gov/
This information is intended for educational purposes only, and should not be interpreted as medical advice. Please consult your physician for advice about changes that may affect your health.